Abstract

BACKGROUND

Insular diffuse glioma resection is at risk of vascular injury and of postoperative new neurocognitive deficits.

OBJECTIVE

To assess safety and efficacy of surgical management of insular diffuse gliomas.

METHODS

Observational, retrospective, single-institution cohort analysis (2005-2019) of 149 adult patients surgically treated for an insular diffuse glioma: transcortical awake resection with intraoperative functional mapping (awake resection subgroup, n = 61), transcortical asleep resection without functional mapping (asleep resection subgroup, n = 50), and stereotactic biopsy (biopsy subgroup, n = 38). All cases were histopathologically assessed according to the 2016 World Health Organization classification and cIMPACT-NOW update 3.

RESULTS

Following awake resection, 3/61 patients had permanent motor deficit, seizure control rates improved (89% vs 69% preoperatively, P = .034), and neurocognitive performance improved from 5% to 24% in tested domains, despite adjuvant oncological treatments. Resection rates were higher in the awake resection subgroup (median 94%) than in the asleep resection subgroup (median 46%; P < .001). There was more gross total resection (25% vs 12%) and less partial resection (34% vs 80%) in the awake resection subgroup than in the asleep resection subgroup (P < .001). Karnofsky Performance Status score <70 (adjusted hazard ratio [aHR] 2.74, P = .031), awake resection (aHR 0.21, P = .031), isocitrate dehydrogenase (IDH)-mutant grade 2 astrocytoma (aHR 5.17, P = .003), IDH-mutant grade 3 astrocytoma (aHR 6.11, P < .001), IDH-mutant grade 4 astrocytoma (aHR 13.36, P = .008), and IDH-wild-type glioblastoma (aHR 21.84, P < .001) were independent predictors of overall survival.

CONCLUSION

Awake surgery preserving the brain connectivity is safe, allows larger resections for insular diffuse gliomas than asleep resection, and positively impacts overall survival.

中文翻译：

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岛叶弥漫性胶质瘤的手术——第 1 部分：经皮层清醒切除是安全的，可独立提高整体生存率

摘要

背景

岛叶弥漫性胶质瘤切除术存在血管损伤和术后新的神经认知缺陷的风险。

客观的

评估岛叶弥漫性胶质瘤手术治疗的安全性和有效性。

方法

观察性、回顾性、单机构队列分析（2005-2019 年）对 149 名接受手术治疗的岛叶弥漫性胶质瘤成人患者：经皮层清醒切除术中功能标测（清醒切除亚组，n = 61），经皮层睡眠切除无功能标测（睡眠切除亚组，n = 50）和立体定向活检（活检亚组，n = 38）。所有病例均根据 2016 年世界卫生组织分类和 cIMPACT-NOW 更新 3 进行组织病理学评估。

结果

清醒切除后，3/61 患者出现永久性运动障碍，癫痫控制率提高（术前为 89% 与 69%，P  = .034），并且尽管接受了辅助肿瘤治疗，测试领域的神经认知能力从 5% 提高到 24%。清醒切除亚组（中位数 94%）的切除率高于睡眠切除亚组（中位数 46%；P  < .001）。与睡眠切除亚组相比，清醒切除亚组的总切除量更多（25% 对 12%），部分切除更少（34% 对 80%）（P  < .001）。Karnofsky 体能状态评分 <70（调整风险比 [aHR] 2.74，P  = .031），清醒切除（aHR 0.21，P = .031)、异柠檬酸脱氢酶 (IDH)  -突变型2 级星形细胞瘤 (aHR 5.17, P = .003)、IDH-突变型 3 级星形细胞瘤 (aHR 6.11, P  < .001)、IDH-突变型 4 级星形细胞瘤 (aHR 13.33) , P  = .008) 和 IDH 野生型胶质母细胞瘤 (aHR 21.84, P  < .001) 是总生存率的独立预测因子。

结论

保持大脑连通性的清醒手术是安全的，与睡眠切除相比，可以对岛叶弥漫性胶质瘤进行更大的切除，并对总体生存率产生积极影响。